Help Protect Your Family s Future

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1 ANA Group Term Life Insurance Plan Help Protect Your Family s Future with affordable ANA Group Term Life Insurance. Everyone dreams, but for dreams to become a reality, they need to be built on a foundation of 1 strength. At The Hartford, our business is to provide that strength. Designed for American Nurses Association Members. Marketed & Administered by: Underwritten by: AmWINS Group Benefits, Inc. Irving, TX Telephone: Hartford Life and Accident Insurance Company Simsbury, CT 06089

2 An offer specifically designed for American Nurses Association members. Planning ahead can often spell the difference between success and failure. When it comes to your family s security, that means adequate life insurance protection. Now is a good time to review your life protection and help make sure it has kept pace with inflation and your changing needs. Take advantage of this valuable Plan. You may choose coverage for yourself and your family. Dependents of Members are also eligible to apply for coverage. Benefits and application procedures are provided in this brochure. Eligibility All Members of the American Nurses Association in good standing and under age 65, who reside in the U.S. and can provide acceptable evidence of insurability, are eligible to apply for coverage. All legal Spouses of Members under age 65, who reside in the U.S. and can provide acceptable evidence of insurability, are also eligible to apply. Unmarried, dependent Children of Members from 6 months to 21 years of age (23, if a full-time student), for whom they provide support, are eligible for coverage as well. When both Spouses are eligible Members, each may apply for coverage as Members ; however, coverage may not be duplicated by applying as dependents of each other. Coverage for Eligible Children may be requested by only one Member. Benefits Members and/or Spouses may apply for benefits ranging from $10,000 to $250,000** (in $10,000 increments). Also, all dependent Children, between 15 days and six months of age, may be covered for $1,000. Dependent Children, between six months and 21 years of age (23, if a full-time student in a school, college, or university), may be covered for $2,500. Acceptance into this Plan is subject to medical evidence of insurability as determined by Hartford Life and Accident Insurance Company. Depending on your age, the amount of coverage you request, and your answers on the Application, a medical examination, medical test(s), or other evidence of good health may be required. Any exams or tests requested by the Hartford Life and Accident Insurance Company will be conducted at your convenience and at no expense to you. Living Benefit Option (Accelerated Death Benefit) Facing a Terminal Illness is a critical time for anyone both emotionally and financially. Most people have friends or family for emotional support, but where do they turn for financial assistance? Hartford Life and Accident Insurance Company s Living Benefits Option may help relieve some of the financial burdens associated with a Terminal Illness. This benefit allows you (and your Spouse, if covered) a one-time option to receive up to 50% of the term life insurance proceeds, from $3,000 to a maximum of $125,000, upon being diagnosed by a physician as having six months or less to live as long as you are under age 70. For example, if you re covered for $100,000 under the Term Life Plan and you become Terminally Ill, you may request an amount between $30,000 and $50,000. However, if you select $30,000 now, you may not request the remaining $20,000 in the future. The funds are received in a lump sum payment without restriction on how you can use them. The face amount of your Term Life policy is then reduced by the accelerated benefit amount paid out. You should consult your personal tax advisor, since the proceeds under this benefit may be taxable. 2

3 You may select benefit amounts from $10,000 - $250,000 in $10,000 increments under age 60 and benefit amount of up to $50,000 if you are QUARTERLY RATES PER $10,000 SMOKER/NON-SMOKER Age Non-Smoker Smoker Member/Spouse Male Female Male Female Under 30 $1.97 $0.97 $4.39 $ $2.06 $1.35 $4.59 $ $2.73 $1.83 $6.10 $ $4.33 $2.85 $9.68 $ $7.17 $4.57 $16.04 $ $12.80 $7.13 $28.67 $ $22.53 $11.77 $50.58 $ $30.71 $15.66 $69.15 $ * $46.87 $25.65 $ $57.68 Rates are based on the attained age of the Insured Person and increase as you enter each new age category. **Benefits reduce to 50% of your insured benefit upon attainment of age 65 with a commensurate reduction in premium. Rates and/or benefits may be changed on a class basis. One or more children: $1.70 quarterly rate. *Renewal Only Coverage Effective Date Your insurance will become effective on the first day of the month following the date Hartford Life and Accident Insurance Company approves your Application and your premium is paid. Dependents coverage begins on the first day of the month following approval of the dependent s application, and provided the required premium is paid. A Member or Spouse must be either Actively-at-Work at least 30 hours per week or able to perform the normal activities of a person of like age and sex in good health on the date his or her insurance is to take effect. If such is not the case, their insurance will take effect the first day of the month following 90 days after the person resumes such activities. Termination Your coverage will remain in force as long as you pay your premiums when due, remain an active Member of the American Nurses Association, you are under age 70, and the Plan remains in force. Coverage for your dependents terminates when they are no longer eligible due to change in age, dependency or marital status. Premiums Non-Smoker and Smoker rates are provided. Smoker means a person who has smoked cigarettes, cigars, or used a pipe or chewing tobacco, nicotine chewing gum, or snuff during the 12 months prior to the date he or she applied for coverage. Non- Smoker means a person who has not smoked cigarettes, cigars or a pipe, or used chewing tobacco, nicotine chewing gum or snuff during the 12 months before submitting an application for insurance. A discount is available to non-smokers. In reviewing the above rates, be sure you select the correct column, depending on whether you re a Smoker or not and what amount of coverage you re selecting.

4 ANA Group Term Life Insurance Plan Waiver of Premium for Disability If you become Totally Disabled before age 60 while you re covered under this Plan and the disability continues for six consecutive months, your life insurance will be continued in force without further premium payment while you remain Totally Disabled. Please note this provision does not apply to dependents benefits. A Total Disability is one which prevents you from engaging in any occupation for wage or profit, and must result from an injury or sickness. Total Disability or an Insured Person s Disability begins before the Insured Person s 60th birthday and while he or she is covered under this Policy; is caused by bodily injury or disease which prevents the Insured Person: from engaging in any occupation or profession for wage or profit; or if not employed, from engaging in the normal and customary activities of a person of like age and sex in good health; and has existed continuously for a period of at least six months. Conversion Privilege If you or your dependent s coverage ends for any reason (unless the policy is canceled, coverage for a class of persons ends, or because of nonpayment of premium), you have the right to request an individual policy without having to provide evidence of insurability. To convert to an individual policy, you must complete a notice of conversion privilege form for the conversion policy and send in the required premium within 31 days from the time your Term Life Plan ends. Complete details may be found in your Term Life Certificate of Insurance. 30-Day Free Review You have a 30 day right to examine the Certificate of Insurance. The certificate may be returned within 30 days of the effective date and all premiums, minus any claims paid, will be refunded. Beneficiary Designation Any person or persons you name may be the beneficiary of this insurance. You can change your beneficiary at any time by giving written notice to the Plan Administrator. Exclusions and Limitations Suicide is excluded for two years from the effective date of each person s coverage. (In the event of death due to suicide, we will only pay an amount equal to the premium paid for coverage to the date of death.)

5 How Do I Apply? 1. Fill out the enclosed Application, including full information about any dependent Child(ren) you want covered. 2. Select the amount of coverage you want (in units of $10,000 up to $250,000). Then, write a check for the proper amount of premium from the Quarterly Rate Table. (Rates are shown for each $10,000 unit of coverage.) 3. Answer the health questions in full and sign your name and the date. 4. Mail your completed Application with your check for your initial quarterly premium payment in the enclosed postage prepaid reply envelope or mail to: AmWINS Group Benefits, Inc. Attn: ANA Insurance Plan P.O. Box Irving, Texas When your Application is approved and your initial premium received, you will be sent your Certificate of Insurance. If you have any questions, please feel free to call the Plan Administrator at this toll-free number: The Hartford is The Hartford Financial Services Group, Inc. and its subsidiaries, including issuing company Hartford Life and Accident Insurance Company. 2 This information is written in connection with the promotion or marketing of the matter(s) addressed in this material. The information cannot be used or relied upon for the purpose of avoiding IRS penalties. These materials are not intended to provide tax, accounting or legal advice. As with all matters of a tax or legal nature, you should consult your own tax or legal counsel for advice. AmWINS Group Benefits, Inc., is the Plan Administrator that administers the insurance plan on behalf of the Hartford Life and Accident Insurance Company for the benefit of the Group Policyholder. AmWINS Group Benefits and American Nurses Association, are compensated for the placement of insurance and for the services it provides to customers on behalf of the insurance company. This brochure explains the general purpose of the insurance described, but in no way changes or affects the policy as actually issued. In the event of a discrepancy between this brochure and the policy, the terms of the policy apply. All benefits are subject to the terms and conditions of the policy. Policies underwritten by the Hartford Life and Accident Insurance Company detail exclusions, limitations, reduction of benefits and terms under which the policies may be continued in full or discontinued. Complete details are in the Certificate of Insurance issued to each insured individual and the Master Policy issued to the policyholder. This program may vary and may not be available to residents of all states. Policy Form # GBD-1000 A (1540) ANA TL

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